...continued from page 49 u rgen tly in ru ral an d p e ri-u rb a n areas. The d ev elo p m en t o f in n er city slu m s, fam ily p sy ch o so cial p rob lem s, in creasin g n u m ­ b ers o f y o u n g an d old p eo p le an d A ID S-re­ lated p ro b lem s are m o u n tin g p re s su re on alread y in ad eq u ate serv ices, an d this at a tim e w h en so cie ty in g en eral, facin g in­ creasin g p o v e rty , is m ak in g p ressin g d e­ m an d s for h ealth an d w elfare services. The h ealth c are s e cto r h as to m eet the challen ge of p ro v id in g accessible, affor­ dable, accep tab le, effectiv e an d equitable h ealth care. W e are g o in g to h a v e to m ak e decisions on the m o st a p p ro p ria te health c are p erso n n el to p ro v id e th ese services, on essen tial, m in im al d ru g lists an d even on non-eligibility for h ealth care. F o r the im m ed iate fu tu re w e are faced w ith the p ro b lem o f p ro v id in g a d eq u ate p rim a ry h ealth c a re w ith o u t the rig h t p erson n el. W e shall h a v e to in volv e co m m u n ities in p lan n in g an d accep tin g in creased resp o n ­ sibility for h ealth c a re , w e shall h a v e to p r o v id e m o r e a p p r o p r i a t e tr a in in g o f health c a re p erso n n el a n d w e shall h a v e to d ecid e on the m a n a g e m e n t role o f local au tho rities an d o f the p rim a r y h ealth care d o cto r. A p p ro p ria te strateg ies w ill h a v e to b e d ev elo p ed to deal w ith AIDS, the aged an d the p oor. W a y s m u st be foun d to c o u n te r the lu re of p riv a te p ra c tic e an d to ac co m m o d a te p riv a te p ra c titio n e rs in n ew h ealth ser­ vices. C o sts w ill h a v e to be c o n tain ed an d this w ill in volve c o st a w a re n e s s, q u ality a ssu r­ ance an d au d itin g p ro g ra m m e s . P ro fesso r Sparks stressed the role o f p ro fe ss io n a l o rg an isatio n s- s u c h as o u r o w n in d e fin in g ro les a n d d e v e lo p in g strategies. W e sh o u ld b e ag en ts for p osi­ tive c h an g e in the p ro v isio n of h ealth ser­ v ices and m u st b e in volv ed in p o lic y -m a k ­ ing, settin g an d m ain tain in g sta n d a rd s, e d u catio n , d esig n in g m a n a g e m e n t p ro to ­ cols an d in a p p ro p ria te research . A s far as ed u catio n al p ro g ra m m e s are co n cern ed , w e m u st m atch w h a t w e teach to the reality w h ich the s tud en ts w ill face. Dr D avid G reen (M A SA p o licy d ivi­ sion , E xecu tiv e D irector o f N A M D A ) a d ­ d ressed the financial issu es in volv ed . H e p oin ted o u t th at to tre a t activ ely the p re ­ d icted n um ber o f AIDS p atien ts in the y ear 2 0 0 0 w o u ld w ip e o u t th e en tire health b u d ­ get. It is ob vio us th at p riorities w ill h a v e to be d eterm in ed , and it is alread y k now n th at the m ain th ru st of h ealth services will be in to p rim a r y h ealth c a re . A fu rth er p rio rity will be th at o f training staff - 1 4 8 clinics built in 1 992 stand e m p ty an d u n ­ u sed d u e to lack o f staff. H e p o stu lated that pub lic h osp itals and clinics m a y b e tran s­ ferred to a D ep artm en t o f Public W ork s, an d th at the D ep artm en t o f H ealth m ig ht ch o o se to b u y services in stead o f p ro v id in g them . A t p resen t reso u rces in the p riv a te sec­ tor are being used in ap p ro priately , w ith too m a n y visits to d o cto rs an d specialists, too m a n y specialised tests o rd e re d an d too m an y p rescrip tion s issued. The M ed ical S ch em es A m en d m en t A ct, w h ich w ill be im p lem en ted to w ard s the en d o f this y ear, w ill c h a n g e th is s itu a tio n d r a s tic a lly . U n d e r this A c t m edical sch em es will be able to w ithhold p a y m e n t fro m p ro v id ers if th ey feel the serv ice p ro v id e d w a s unjus­ tified. These p ro v id ers include p h y sio th er­ ap ists, w h o up to n ow h a v e been p ro tected u n d er the A ct. The A c t p ro v id es incentive for the fo rm atio n of health m an ag em en t s c h e m e s a n d g r o u p p r a c tic e s , a n d b y Ja n u a ry 1 9 9 4 financiers of h ealth services w ill be able to pick "p re fe rre d p ro v id e rs" - th ose w h o p ro v id e the m o st cost-effective services. A s far as h ealth m a n ag em en t sch em es an d gro u p p ractices are co n cern ed , b u d ­ getin g p o licy m a y w ell giv e in centive n ot to inclu de p h y sio th erap ists on their staff or ev e n to b u y their services! Som e balances w ill b e n ecessary in o rd er to en su re that p atien ts receiv e n e ce s sa ry tre a tm e n t, b u t p h y sio th erap ists w ill h a v e to m a rk e t the n ecessity for their serv ices. T h e ch an g es in th e a d v e r t i s i n g r u l e s , to b e g a z e t t e d s h o rtly , will allow us to d o this. A lth o u g h itis u nlikely th at the su p p ly o f p h y sio th er­ ap ists w ill e x c e e d th e c o u n tr y 's d em an d , w e shall h a v e to a c ce p t ch an g e. It m a y be n e ce s sa ry to re-lo cate o r to c h an g e from in dep end en t p riv a te p ra c tic e to w ork in g w ith a g ro u p p ra c tic e o r H M O . A b o v e all, p h y sio th erap ists w ill h a v e to le a rn to w ork cost-effectively . P ro fe ss o r B o w erb an k , P h y sio th e ra p y D e p a rtm e n t, U n iv e rs ity o f C a p e T ow n , took the th em e o f the c o n g re s s - F u tu re Shock - as the o p en in g p o in t for h er co n ­ tribution. She p o in ted o u t th a t sho ck w as follow ed b y a p e rio d o f in ca p a city cau sed b y s u c ce s s iv e d en ial, b lam e, self-blam e an d u n certain ty . A ctio n is n eed ed n ow to avo id this dip in p e rfo rm a n c e an d to e m ­ b ark alre a d y o n p ro b le m -so lv in g for the future. She ask ed w h a t vision w e h a v e for the fu tu re, an d w h e th e r w e all sh are the sam e vision . W h a t is o u r resp on sib ility as a p ro ­ fessio n in c a te rin g to th e n eed s o f the co u n try , an d h ow d o w e e n su re th at w e a c ce p t th a t resp o n sib ility ? W h a t is ou r v a lu e -s y s te m for th e p ro fessio n a s reg ard s b oth p atien t c a re an d the ed u catio n o f fu­ tu r e p h y s i o t h e r a p i s t s ? W h a t s tr a te g ic plan s sh o u ld w e b e m ak in g for the future an d h o w w ill th ese affect the special inter­ e s t g r o u p s w ith in th e p ro fe s s io n ? She p oin ted o u t th at w e h a v e to ackn ow led ge th at n o t all p h y sio th erap ists c a n w o rk in all fields - w e h a v e to feel p sy ch o lo g ically safe in o u r w o rk - b u t th at to g eth er w e can s u p p o r t o n e a n o t h e r in p r o v i n g th e p h y sio th erap y serv ices w h ich the co u n try n eed s. She closed w ith a quote: "If y o u d o n o t k n o w w h e re y o u are go in g , y o u m a y en d up so m e w h e re else an d n o t ev en k no w it." S Irwin-Carruthe FROM THE LITERATURE Title: Diagnostic Classification o f Patients with Low Back Pain. Author: Binkley e ta l. Journal: Physical Therapy 1993;75(3)138-144. A survey was undertaken to establish the le v e l o f a g r e e m e n t am on g o rth o p a e d ic physiotherapists on diagnostic classes of LBP and associated clinical findings. By use of the Delphi Technique, three diagnostic classes were agreed upon, thesebeing hypomotility dysfunc­ tion, nerve root adhesion and sacro-iliac dys­ function. There was less agreement regarding the other 22 diagnostic classes. Further survey w ill e x a m in e the r e lia b ility w ith w h ic h physiotherapists use the classification system. Title: The Effects of an Aids Education Program on the Knowledge and Attitudes of a Physical Therapy class ^ ■ 1 Author: Held SL Journal: Physical Therapy 1993;75(3)156-164 Undergraduate students were surveyed re­ garding their knowledge and attitudes to AIDS before and after an education programme on the disease. (Similar surveys were carried out by South African students and papers on their findings were given at the recent Congress). Title: Implications of Elbow Arthrodesis for Individ­ uals with Paraplegia Author: Young JH Journal: Physical Therapy 1993;75(3)194-201 The case report discusses the advantages and disadvantages of two different positions in which the elbow could be fused to allow for maximum independence. The author stresses the importance of the physiotherapist in con­ sidering the biomechanical needs of patients when options in surgical decisions are required. Title: Incidence of Injury in Rugby League Football Author: Gissom e e t al. Journal: Physiotherapy 1993;79(5)305-310 The number of injuries incurred at one pro­ fessional Rugby League club are recorded and the implications for physiotherapists working with such teams are discussed. The role of physiotherapy is not only one of rehabilitation but includes counselling and warning players and coaches of the potential for injury and the way of preventing these. The Norwegian physiotherapy journal for May 1993 covers various aspects of Physiology and its relevance to physiotherapy. These in­ clude articles on: • Muscle fatigue and preventive strategies • Weight training and osteoporosis • Behavioural and psychological factors which may influence components of the immune system. JC Beenhakker l rapie, Augustus 1993 Dee! 49 No 3 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )